Pilot Testing a Coaching Intervention to Improve Certified Nursing Assistants' Dressing of Nursing Home Residents.

The purpose of the current study was to identify initial effects of a coaching training intervention using Level of Assistance (LoA) strategies compared with traditional lecture techniques on the appropriateness of LoA use by certified nursing assistants (CNAs) and independence of dressing of nursing home residents with dementia. Seventeen CNA-resident dyads participated in this pilot randomized controlled trial (RCT). Control and experimental group CNAs received a 25-minute traditional lecture. Experimental group CNAs also underwent three coaching sessions over 4 weeks. There were significant between-group differences in the percentage of dyads who had improved scores for appropriateness of LoA use and dressing independence from pretest to posttest (experimental: n = 9, 100%; control: n = 8, 50%; p = 0.029). However, there were no statistically significant median differences between groups in appropriateness of LoA use by CNAs and resident dressing independence scores. There were significant within-group median improvements in appropriateness of LoA use (p = 0.004) and independence of dressing scores (p = 0.004) between pretest and posttest in the experimental group, but not in the control group. This initial pilot RCT supports coach training as a method to improve appropriate use of LoA strategies by CNAs and independence of resident dressing. [Res Gerontol Nurs. 2017; 10(6):267-276.].

Patient aggression experienced by staff in a New Zealand public hospital setting.

AIMS: Working in a healthcare environment is a known risk factor for violence. Patient aggression towards staff is often present in a hospital setting but the extent, type and variation among various occupations and roles are not known. METHOD: This research examines the type and frequency of aggression experienced by healthcare staff, using a previously used measure the POPAS-NZ, which is a short pen and paper survey. Responses were gathered from 227 people working in a single district health board. RESULTS: Responses showed verbal anger was experienced by 93% of healthcare workers in the previous year and physical aggression was experienced by 65% of respondents. Also, 38% of staff reported experiencing a physical assault in the previous year. When analysed by role it was found that nurses and support staff experienced the greatest number of aggressive incidents compared to doctors and allied health staff. No effects of gender of the healthcare worker were found. Psychiatric units showed greater levels of destructive behaviour and attempted assaults but were similar to other areas of the hospital on all other measures. CONCLUSION: These results demonstrate many hospital staff, of all roles and workplaces experience aggression on a frequent basis. Implications for staff training are discussed.

How do intoxicated patients impact staff in the emergency department? An exploratory study.

AIM: To investigate staff perceptions of the burden of alcohol-related presentations on emergency departments (ED) in New Zealand and the impact on staff of alcohol-related ED presentations. METHODS: A survey of Wellington Regional Hospital ED staff was conducted using a written questionnaire to measure the impact of alcohol on: staff assault rates, perceived workload, quality of care, and staff mood. In addition, semi-structured interviews were conducted with six ED staff to further explore impacts of alcohol on ED, analysed using thematic analysis. RESULTS: Forty-seven staff members responded to the questionnaire. Assault rates from alcohol-affected patients were high, particularly amongst nurses. These were mostly verbal assaults. Staff mood was negatively affected and perceptions of workload increased by alcohol-related presentations. Views on whether quality of care of intoxicated patients was affected were mixed although most reported a negative impact on other patients. Interviews confirmed the survey results, confirming the negative impacts of alcohol-related presentations on staff and on the treatment of both intoxicated and non-intoxicated patients. CONCLUSION: This small exploratory study found that alcohol-related presentations have a negative impact on ED staff workload and safety, and may compromise treatment of all patients. More research is needed to corroborate these findings and to investigate policies to reduce the impacts of alcohol-related presentations in the ED.

Myocardial hypertrophy and the maturation of fatty acid oxidation in the newborn human heart.

After birth dramatic decreases in cardiac malonyl CoA levels result in the rapid maturation of fatty acid oxidation. We have previously demonstrated that the decrease in malonyl CoA is due to increased activity of malonyl CoA decarboxylase (MCD), and decreased activity of acetyl CoA carboxylase (ACC), enzymes which degrade and synthesize malonyl CoA, respectively. Decreased ACC activity corresponds to an increase in the activity of 5'-AMP activated protein kinase (AMPK), which phosphorylates and inhibits ACC. These alterations are delayed by myocardial hypertrophy. As rates of fatty acid oxidation can influence the ability of the heart to withstand an ischemic insult, we examined the expression of MCD, ACC, and AMPK in the newborn human heart. Ventricular biopsies were obtained from infants undergoing cardiac surgery. Immunoblot analysis showed a positive correlation between MCD expression and age. In contrast, a negative correlation in both ACC and AMPK expression and age was observed. All ventricular samples displayed some degree of hypertrophy, however, no differences in enzyme expression were found between moderate and severe hypertrophy. This indicates that increased expression of MCD, and the decreased expression of ACC and AMPK are important regulators of the maturation of fatty acid oxidation in the newborn human heart.

The lymphoid cell surface receptor NTB-A: a novel monoclonal antibody target for leukaemia and lymphoma therapeutics.

NTB-A is a CD2-related cell surface protein expressed primarily on lymphoid cells including B-lymphocytes from chronic lymphocytic leukaemia (CLL) and lymphoma patients. We have generated a series of monoclonal antibodies (mAbs) against NTB-A and assessed their therapeutic potential for CLL. Selective mAbs to NTB-A were further tested in functional complement-dependent cytotoxicity (CDC) and antibody-dependent cellular cytotoxicty (ADCC) assays in cell lines and B lymphocytes freshly isolated from CLL patients. While lower levels of NTB-A were detected in T and natural killer (NK) cells, CDC activity was demonstrated primarily in B cells isolated from CLL patients and B lymphoma cell lines. Knockdown of NTB-A by small interfering RNA in target cells results in lower cytotoxicity, demonstrating the specificity of the mAbs. Furthermore, anti NTB-A mAbs demonstrated anti-tumour activity against CA46 human lymphoma xenografts in nude mice and against systemically disseminated Raji human lymphoma cells in severe combined immunodeficient mice. Taken together, these results demonstrate NTB-A as a potential new target for immunotherapy of leukaemia and lymphomas.